Health care in 3 charts
February 24, 2012 4 Comments
So, this week was time for me to update my health care policy lecture for the first time in three years. Much updating to be done. For starters, I hit upon a much better way to start. I simply show what’s wrong with health care in the US in three charts and once the scope of the problem is obvious the rest of the lecture is how we got here and what we can do about it.
So, to start, cross-national per capita health care spending is pretty damning.
Of course, if that were resulting in us being way healthier, maybe it would be worth it. Back in the old days, I used to show a comparative life expectancy chart (we don’t fare so well), but since becoming a quasi health care wonk thanks to years of reading Ezra and Jon Cohn, I realized than health care amenable mortality is the way to go. So, that’s next. In short, despite all that spending, Americans die at much higher rates from things that could have prevented with proper health care treatment.
And last, we don’t even bother to get all Americans covered with this extra spending. I had to make this chart myself. Nobody bothers assembling a chart where basically all the countries but one are at 100%.
The Affordable Care Act ain’t perfect, but I can guarantee you Health Savings Accounts and buying insurance across state lines aren’t exactly going to solve these problems.
About Steve Greene
I actually think progressive HSAs plus single-payer universal catastrophic insurance is the way to go, thanks to reading years of Brad DeLong and Yglesias. But alas, since it combines the one thing anathema to progressive (icky cost-sharing) and the one thing anathema to conservatives (icky government-run anything), it’s a pipe dream.
1) I don’t think cost-sharing is anathema to liberals. It’s not like Medicare doesn’t have significant cost-sharing and most liberals would absolutely jump at a “Medicare for all” plan.
2) My understanding is that there’s not much evidence that cost-sharing actually works to keep medical costs down. If it did, all the good liberal health wonks would be all for it.
3) What do you actually mean by “progressive” HSAs?
The single-payer bills in Congress (H.R. 676, for example) expand Medicare to everyone and do away with cost-sharing. I certainly agree with you that expanding Medicare, deductibles and coinsurance and all, would be a wonderful accomplishment in the eyes of all progressives, but for many the ideal point is care free at the point of use.
Maybe it’s been a while since I’ve read anything on the HMO revolution in the 90s, but I thought the general consensus was that managed care and high-deductible policies decreased (or at least substantially slowed the growth of) costs.
By progressive HSAs, I mean mandatory savings accounts ranging from, say 5-15 percent of a person’s income. This would be the deductible and anything above and beyond covered by insurance. For the HSA part to work, you’d need the unused portions to be refundable so individuals would have some incentive to be selective with health care utilization. Of course, the vast vast majority of health care savings would come from the insurer negotiating prices downwards. But I don’t think the effects on costs from HSAs would be insignificant. See Jason Furman: http://www.brookings.edu/papers/2007/04useconomics_furman.aspx
I like that progressive element, but I suspect that Furman seriously overstates the cost-saving benefit. Also, the data that show that under-utilization of needed services had no negative effects is really old. You’ve also got to be really careful about what has cost sharing and what doesn’t. Actually, seems like France is pretty damn good at this. I think we’d be better trying to adopt and slightly modify their system than trying to re-invent the wheel.
I did not realize that about the House Bill you mention, but I would argue that the only thing that is truly anathema to liberals is a health care “reform” that doesn’t actually work to expand affordable coverage to all Americans.